HIV Prevention for Women: Much More Than Condoms

For the first time, research on gender and HIV in Colombia is focused not solely on "groups at risk," but on the social context and conditions that increase the vulnerability among women to HIV transmission.

The research, which just completed, was developed by the Interdisciplinary Group of Gender Studies and medical anthropologists from from the National University of Colombia, and supported by the United Nations Population Fund, (UNFPA).

The revealing study, "Vulnerability Factors Among Women to the HIV Infection," was carried out in five Colombian cities, in order to study the regional specificities, because Bogotá (the capital) is not a sufficient example of the epidemic’s development. In fact, health care delivery doesn’t work in the same way across the country, due to the fact that the local cultures have diverse gender approaches, which are relevant to analyze women’s vulnerability to the virus.

The different Colombian regions have diverse values when it comes to marriage, couple, family, maternity, fidelity and the woman’s right to decide to be alone.

Comparing the regions instead of homogenizing the studies and the HIV campaigns is the valuable contribution of this research.

In terms of vulnerability factors, the study was focused in two of them: The erotic-affection relations and the women’s relations within the health system, both viewed as linked factors rather than subjective and structural aspects. Consequently the research created focal groups of women living with and without HIV, and conducted in-depth interviews with them. Researchers also contacted the local health authorities and persons in charge of HIV programs in each city.

The research concluded that the vulnerability circumstances of women to get infected by the virus are not only due sexual contact with an HIV infected person, but also a conjunction of living conditions which lead to vulnerable situations for women.

These living conditions vary, but all of them led to a low capacity of negotiation regarding women’s sexual and reproductive life, which also links to women’s need to be accompanied, to play the role as wives and mothers and to sacrifice their own welfare in order to satisfy the need of children and partner or husband.

For Angela Facundo, research group’s field coordinator, the women’s analysis is slanted, and leaned to a victimization approach. She discussed women’s inability to negotiate condom use with their partners or husbands. Whereas, in the interviews, some women expressed feeling low level of pleasure when using the condom, and said they sometimes asked for sexual relations without a condom. As for the female condom, it is not yet accessible in Colombia, and it has not been promoted by prevention campaigns.

In general, women feel safe with their husband or permanent partner. They felt that love is a protection factor, so they do not request that a condom is used, avoiding conflict. Whereas in sexual extramarital affairs, women do not hesitate to use condoms.

Facundo notes that we can view HIV vulnerability from moral and victimization approaches. At the beginning, HIV-AIDS was believed to be a problem for gays, prostitutes and black people. When the epidemic touched women, the victimization interpretation appeared.

"When we look at the cases of heterosexual women, who follow the moral recommendations of fidelity and monogamy, we realize that the prevention strategy does not work. At this point another target to blame comes up: Bisexual men. So the heterosexual women living with the virus are represented as the victims of bisexual men."

According to Facundo, morality and victimization are obstacles to accurate analysis from a social perspective, and ethical public health approaches.

So for the researchers, it is not enough to develop HIV prevention campaigns based 100 percent on the use of condoms but also needs to focus on women’s empowerment, which will also lead them to economic and autonomous development.

Moreover, the research reveals that there is not a lot of open communication between health care staff and women. "There are mistreatments, the relationship is very vertical. Sometimes the HIV test is denied by the health care staff, the information brought to women is focused on epidemiology aspects, ignoring sexual and reproductive rights. There is an absence of counseling on social networks, which are relevant for women living with HIV," Facundo said.

The research shows a need to improve the prevention strategies in terms of information, health care attention, and implementation of social networks and discrimination, which will generate economic empowerment among Colombian women.

To schedule an interview with Angela Castellanos contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

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A very interesting study! There is growing recognition that addressing “upstream” vulnerability factors for women and girls is an important task in HIV and other health and development progreammes. This study goes farther, investigating intra-national variation in these vulnerability factors, and doing so in a Latin American context.

The study appears to make a number of valuable and unusual contributions. I would appreciate receiving a copy of the full report.